This version of the form is not currently in use and is provided for reference only. Download this version of Form DHS-6806-ENG for the current year.
This is a legal form that was released by the Minnesota Department of Human Services - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is the DHS-6806-ENG form?
A: The DHS-6806-ENG form is the Telehealth Provider Assurance Statement for Minnesota Health Care Programs (MHCP).
Q: What is telehealth?
A: Telehealth is the use of technology to deliver healthcare services remotely.
Q: Who is required to fill out the DHS-6806-ENG form?
A: Providers participating in Minnesota Health Care Programs (MHCP) and offering telehealth services are required to fill out this form.
Q: What is the purpose of the Telehealth Provider Assurance Statement?
A: The purpose of this statement is to ensure that providers are aware of and compliant with the requirements for telehealth services under MHCP.
Q: What information is required to be included in the DHS-6806-ENG form?
A: The form requires providers to provide information about their telehealth services, such as the type of services offered and the technology used.
Q: Are all telehealth providers required to fill out this form?
A: Yes, all providers offering telehealth services under MHCP are required to fill out this form.
Q: Is there a deadline for submitting the DHS-6806-ENG form?
A: The form should be submitted as soon as possible, and providers should update the form if there are any changes to their telehealth services.
Q: Is there any fee associated with submitting the DHS-6806-ENG form?
A: No, there is no fee associated with submitting this form.
Q: Who should I contact if I have questions or need assistance with the DHS-6806-ENG form?
A: You can contact Minnesota Health Care Programs (MHCP) for assistance with the DHS-6806-ENG form.
Form Details:
Download a fillable version of Form DHS-6806-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.